Cardiopulmonary exercise testing: does it improve perioperative care and outcome?

We reviewed recent articles, guidelines, and meta-analyses concerning the use of cardiopulmonary exercise testing (CPET) in preoperative risk evaluation and fitness for surgery. When the risk of surgery mortality is high (e.g. >5%), and/or the preoperative state of the patient indicates increased propensity toward morbidity and mortality (advanced age, presence of cardiovascular risk factors, multisystem disease, poor functional status, and so on), the thoroughness of the perioperative assessment should be intensified beyond the standard history and physical, basic laboratories, and electrocardiogram stress testing to include CPET.

The CPET variables of peak oxygen uptake, anaerobic threshold, oxygen pulse, and ventilatory efficiency appropriately focus upon the cardiopulmonary reserve required to respond to metabolic stress and, therefore, are ideal to predict operative surgery outcomes. The focus should not be on using CPET to deny surgery to patients, but rather to define the level of postoperative care required to minimize risk.

Using a small number of important variables obtained from CPET an accurate picture of the patient's future response to perioperative stress can be obtained. Consideration should be given to performing a CPET in any preoperative patient who has increased risk or is scheduled to undergo a high risk surgical intervention. This strategy assists the anesthetist, surgeon, patients, and their families in appropriate perioperative planning.